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CDCES Cheat Sheet

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Assessment

  • 25% of exam
  • Diagnostic Criteria Autoantibodies & C-Peptide Readiness & Literacy Tools Psychosocial Screening Diagnosis Pathway Tree

Care and Education Interventions

  • 70% of exam
  • ADCES7 Insulin Pharmacology Non-Insulin Agents MNT & Insulin Math Glycemic Targets Glucose Monitoring Acute Complications Chronic Complications Physical Activity Special Populations

Standards and Practices

  • 5% of exam
  • NSDSMES 6 Standards Four Critical Times DSMT Medicare Benefit Population Health & DPP

Quick Facts

  • Exam CDCES
  • Body CBDCE
  • Items 175 (150 scored)
  • Time 4 hours
  • Pass Scaled 70 of 99
  • Pass rate 63% first-time
  • Domains 3 weighted domains
  • Fee $350
  • Provider PSI, test center or LRP
  • Validity 5 years

SMART Goals AS

  • Specific, Measurable, Achievable, Relevant, Time-bound goals
  • S: specific behavior M: measurable target A: achievable step R: relevant to person T: time-bound deadline

Type 1 vs Type 2 Pathophysiology AS

Type 1

  • Autoimmune beta-cell destruction
  • Absolute insulin deficiency
  • Islet autoantibodies present
  • Low or undetectable C-peptide

Type 2

  • Insulin resistance, muscle/liver/fat
  • Relative, progressive deficiency
  • Autoantibodies typically negative
  • Normal to high C-peptide
  • Absolute deficiency vs insulin resistance

Diabetes Diagnosis Pathway AS

  • A1C 6.5% or higher → Diabetes, confirm w/ repeat ( Any one criterion suffices )
  • FPG 126 mg/dL or higher → Diabetes, confirm w/ repeat ( No caloric intake 8 hr )
  • 2-hr OGTT 200+ mg/dL → Diabetes, confirm w/ repeat ( 75-gram glucose load )
  • Random glucose 200+ w/ symptoms → Diabetes, no repeat needed ( Classic hyperglycemia symptoms )
  • A1C 5.7 to 6.4% → Prediabetes ( Can meet multiple criteria )
  • FPG 100 to 125 mg/dL → Prediabetes (IFG) ( May overlap A1C criterion )

ADA Diagnostic Criteria AS

  • Diabetes A1C 6.5% or higher
  • Diabetes FPG 126 mg/dL or higher
  • Diabetes 2-hr OGTT 200 mg/dL or higher
  • Diabetes random glucose 200+ with symptoms
  • Prediabetes A1C 5.7 to 6.4%
  • IFG (prediabetes) FPG 100 to 125
  • IGT (prediabetes) OGTT 140 to 199

Dawn Phenomenon vs Somogyi Effect AS

Dawn phenomenon

  • 2-3 AM glucose normal/rising
  • Hormone-driven surge
  • Fix: adjust basal timing/dose

Somogyi effect

  • 2-3 AM glucose low
  • Rebound hyperglycemia after
  • Fix: reduce evening insulin
  • Check 2-3 AM glucose to distinguish

Autoantibodies and C-Peptide AS

  • GAD65 Islet autoantibody, T1D/LADA
  • IA-2 Islet autoantibody, T1D
  • IAA Insulin autoantibody
  • ZnT8 Islet autoantibody, T1D
  • Low C-peptide Minimal endogenous insulin
  • High C-peptide Insulin resistance, type 2

Readiness and Literacy Tools AS

  • Teach-back Person restates in own words
  • Transtheoretical Model Stages of change
  • Precontemplation stage Not yet considering change
  • Action stage Actively changing behavior
  • Maintenance stage Sustained 6+ months
  • Cost-adherence question Ask cutting back at every visit

Psychosocial Screening AS

  • Diabetes distress Emotional burden of self-care
  • DDS tool Diabetes Distress Scale
  • PAID tool Problem Areas in Diabetes
  • Distress screening frequency At least annually
  • Distress vs depression Distinct but can overlap

ADCES7 Self-Care Behaviors CA

  • Coping, Eating, Active, Medication, Monitoring, Risk, Problem-solving
  • Healthy Coping: center Healthy Eating: MNT Being Active: exercise Taking Medication: adherence Monitoring: SMBG/CGM Reducing Risk: screening Problem Solving: sick days

DKA vs HHS CA

DKA

  • Glucose usually over 250
  • pH under 7.3, ketones positive
  • Rapid onset, hours
  • Typically type 1

HHS

  • Glucose usually over 600
  • pH normal, ketones minimal
  • Gradual onset, days
  • Typically type 2, older
  • Acidotic vs hyperosmolar crisis

Hypoglycemia Response Steps CA

  • Glucose 54-69, conscious → 15g fast carb, recheck 15 min ( Level 1 alert value )
  • Glucose under 54, conscious → 15g fast carb, recheck 15 min ( Level 2, treat urgently )
  • Still under 70 after 15 min → Repeat 15g carb ( Rule of 15 )
  • AID/pump user, mild low → 5 to 10g carb ( Pump already reducing insulin )
  • Cannot swallow safely → Give glucagon ( Not oral carbohydrate )
  • Unconscious or seizing → Glucagon, position on side ( Call EMS if no response )

ADCES7 Self-Care Behaviors CA

  • Healthy Coping Center of the framework
  • Healthy Eating MNT and carb counting
  • Being Active Aerobic and resistance training
  • Taking Medication Adherence and safe use
  • Monitoring SMBG, CGM, ketones
  • Reducing Risk Complication prevention, screening
  • Problem Solving Sick days, hypo/hyper response

15-15 Rule CA

  • 15 grams fast carb, wait 15 minutes, recheck glucose
  • Glucose under 70: treat Give 15g fast carb Wait 15 minutes Recheck, repeat if low

Rapid-Acting vs NPH Insulin CA

Rapid-acting

  • Onset 10 to 15 minutes
  • No pronounced late peak
  • Used in pumps, boluses

NPH

  • Onset 1 to 2 hours
  • Pronounced 4-12 hr peak
  • Cloudy, roll before dosing
  • Mealtime bolus vs peaking basal

Pre-Exercise Safety Check CA

  • Glucose under 90 mg/dL → Eat 15-30g carb first ( Recheck in 15 minutes )
  • Glucose 90 to 250 mg/dL → Proceed with exercise ( Normal range )
  • Glucose over 250, ketones negative → Proceed with caution ( Monitor closely )
  • Glucose 250-349 with ketones → Do not exercise ( Correct ketosis first )
  • Glucose 350+ mg/dL → Do not exercise ( Regardless of ketone result )

Insulin Onset, Peak, Duration CA

  • Rapid-acting onset 10 to 15 minutes
  • Rapid-acting duration 3 to 5 hours
  • Regular insulin onset About 30 minutes
  • Regular insulin use Only IV form, DKA/HHS
  • NPH onset/peak 1-2 hr onset, 4-12 hr peak
  • NPH handling Roll gently, never shake
  • Glargine/detemir profile No pronounced peak, 24 hr
  • Degludec duration Over 42 hours, flattest
  • U-500 use Severe resistance, over 200u/day

Insulin Dose Rules CA

  • 500 for carb ratio, 1800 for correction factor
  • 500 / TDD = ICR 1800 / TDD = correction, rapid 1500 / TDD = correction, regular

GLP-1 RA vs SGLT2 Inhibitor CA

GLP-1 RA

  • Glucose-dependent insulin release
  • MTC boxed warning
  • Avoid with pancreatitis history

SGLT2 inhibitor

  • Blocks renal glucose reabsorption
  • Euglycemic DKA risk
  • Genital mycotic infection risk
  • Incretin effect vs renal glucosuria

Non-Insulin Agent Risks CA

  • Metformin mechanism Reduces hepatic glucose output
  • Metformin eGFR cutoff Contraindicated under 30
  • Metformin B12 risk Deficiency in 5-10% long-term
  • GLP-1 boxed warning Medullary thyroid carcinoma risk
  • GLP-1/tirzepatide effect Weight loss, slowed emptying
  • SGLT2 mechanism Blocks renal glucose reabsorption
  • SGLT2 key risk Euglycemic DKA, glucose under 200
  • Sulfonylurea risk Highest hypoglycemia of orals
  • Glyburide risk Highest in class, elderly

rtCGM vs isCGM CA

rtCGM

  • Streams data continuously
  • Customizable high/low alarms

isCGM

  • User scans to retrieve data
  • No continuous background alarm
  • Continuous stream vs scan to view

MNT and Insulin Dose Math CA

  • Carb serving 15 grams carbohydrate
  • Rule of 500 (ICR) 500 divided by TDD
  • Rule of 1800 1800 divided by TDD, rapid
  • Rule of 1500 1500 divided by TDD, regular
  • Sugar alcohols About 2 kcal per gram
  • Nonnutritive sweeteners Little to no calories

Glycemic Targets CA

  • General A1C goal Under 7%
  • Preprandial glucose 80 to 130 mg/dL
  • Peak postprandial glucose Under 180 mg/dL
  • Time in Range goal Over 70%
  • Time Below Range 1 Under 4%, glucose under 70
  • Time Below Range 2 Under 1%, glucose under 54
  • GMI formula 3.31 + 0.02392 x mean glucose

Glucose and Ketone Monitoring CA

  • SMBG technique Wash hands, side of finger
  • rtCGM Streams data, custom alarms
  • isCGM Flash, scan to retrieve
  • Sensor wear 10 to 15 days
  • BHB testing trigger Glucose over 240, illness
  • BHB high-risk level 1.6 to 3.0 mmol/L
  • BHB DKA-likely level Over 3.0 mmol/L

Acute Complications CA

  • Hypo Level 1 54 to 69 mg/dL
  • Hypo Level 2 Under 54 mg/dL
  • Hypo Level 3 Severe, needs assistance
  • 15-15 Rule 15g carb, recheck 15 min
  • AID-user hypo dose 5 to 10 grams carb
  • Severe hypo treatment Glucagon, not oral carb
  • DKA glucose Usually over 250 mg/dL
  • DKA pH/bicarb pH under 7.3, bicarb under 18
  • HHS glucose Usually over 600 mg/dL
  • HHS ketones Minimal or absent

Chronic Complications Screening CA

  • T1D retinopathy start Within 5 years diagnosis
  • T2D retinopathy start At diagnosis
  • UACR normal Under 30 mg/g
  • UACR severely increased 300 mg/g or higher
  • Neuropathy tool 10-gram monofilament
  • Neuropathy tool 2 128-Hz tuning fork
  • Charcot foot sign Warm, red, pulse present
  • Charcot treatment Immediate offloading, casting

Physical Activity Guidance CA

  • Aerobic target 150+ min/week moderate
  • Resistance target 2 to 3 sessions/week
  • Sitting break rule Interrupt every 30 minutes
  • Pre-exercise glucose low Under 90, eat 15-30g carb
  • Delayed hypoglycemia Hours later, even overnight

Pregnancy and GDM Targets CA

  • Pregnancy fasting glucose Under 95 mg/dL
  • Pregnancy 1-hr postprandial Under 140 mg/dL
  • Pregnancy 2-hr postprandial Under 120 mg/dL
  • Pregnancy A1C goal Under 6%
  • GDM screening window 24 to 28 weeks
  • Postpartum GDM retest 75-g OGTT, 4-12 weeks

NSDSMES 6 Standards ST

  • Standard 1 Support for DSMES services
  • Standard 2 Population and service assessment
  • Standard 3 DSMES team
  • Standard 4 Delivery and design
  • Standard 5 Person-centered DSMES
  • Standard 6 Measuring, demonstrating outcomes

Critical Times and DSMT Benefit ST

  • Critical Time 1 At diagnosis
  • Critical Time 2 Annually, not meeting targets
  • Critical Time 3 New complicating factors
  • Critical Time 4 Life or care transitions
  • Medicare DSMT year one Up to 10 hours
  • Medicare DSMT after year one 2 hours per year

Common Traps

Dawn Phenomenon vs Somogyi

  • Dawn: rising overnight glucose ≠ Somogyi: overnight low, rebound

DKA vs HHS Onset

  • DKA: rapid, hours, type 1 ≠ HHS: gradual, days, type 2

SGLT2 Euglycemic DKA

  • Glucose often looks normal ≠ Check ketones on symptoms alone

NPH Handling Error

  • Must roll gently before use ≠ Never shake the suspension

Milking the Fingerstick

  • Dilutes sample with tissue fluid ≠ Use adequate first drop instead

Level 3 Hypoglycemia Definition

  • Not a specific glucose number ≠ Defined by needing assistance

Rule of 1800 vs 1500

  • 1800 divided by TDD, rapid ≠ 1500 divided by TDD, regular

Last Minute

  • 1. Assessment 25%, Care 70%, Standards 5%
  • 2. 175 items, 150 scored, 4 hours
  • 3. Passing score: scaled 70 of 99
  • 4. A1C diagnosis cutoff is 6.5%
  • 5. General A1C target under 7%
  • 6. Preprandial target 80-130 mg/dL
  • 7. Time in Range goal over 70%
  • 8. Rapid-acting onset 10-15 minutes
  • 9. SGLT2i risk: euglycemic DKA
  • 10. GLP-1 boxed warning: MTC/MEN2
  • 11. Metformin contraindicated eGFR under 30
  • 12. 15-15 Rule for non-severe hypoglycemia
  • 13. Severe hypo treated with glucagon
  • 14. DKA acidotic, HHS hyperosmolar
  • 15. ADCES7 centers on Healthy Coping

CDCES

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